Information Collection

Instruments for Wave 2 of the PATH Study

IC 212557 under ICR 201407-0925-004 · OMB 0925-0664.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0664 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Instruments for Wave 2 of the PATH Study	Form and Instruction
1-Rev English Version 2_PATH_Study_Data_Collection_Instruments.pdf	Form and Instruction
1 Spanish Version 2-PATH_Study_Data_Collection_Instruments-Spanish.pdf	Form and Instruction
2 Follow up, Retention and Tracking Documents - English Ve 9_Follow-up_Retention_and_Tracking.pdf	Form and Instruction
2 Follow up, Retention and Tracking Documents - Spanish Ve 9_Follow-up_Retention_and_Tracking_Spanish.pdf	Form and Instruction
5 Summary of Changes to Instruments for W2 6-27-2014.pdf Summary of Changes to the Instrument	IC Document
6_Additional_Information_on_Biospecimens.pdf Additional Biospecimen Informatiion	IC Document
19_Field_Data_Collection_Materials.pdf Field Materials - English	IC Document
19_Field_Data_Collection_Materials_Spanish.pdf Field Materials - Spanish	IC Document
17_Procedures_for_Keeping_Data_Confidential.pdf Data Confidentially Procedures	IC Document
18_ICPSR_Data_Use_Agreement.pdf Data Use Agreement	IC Document
8_Key_Design_Features.pdf Key Survey Design Features	IC Document

IC Title:

Instruments for Wave 2 of the PATH Study

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Spanish Version	2-PATH_Study_Data_Collection_Instruments-Spanish.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	1-Rev	English Version	2_PATH_Study_Data_Collection_Instruments.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Follow up, Retention and Tracking Documents - English Version	9_Follow-up_Retention_and_Tracking.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	2	Follow up, Retention and Tracking Documents - Spanish Version	9_Follow-up_Retention_and_Tracking_Spanish.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-25-0200 ooClinical, Basic and Population-basedR esearchS tudieso f the National Institutes of Health (NIH), HHSAIIH/OD

FR Citation: 67 FR 60741

Number of Respondents: 41,745

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	193,243	193,243
Annual IC Time Burden (Hours)	56,939	56,939
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Summary of Changes to the Instrument	5 Summary of Changes to Instruments for W2 6-27-2014.pdf	07/31/2014
Additional Biospecimen Informatiion	6_Additional_Information_on_Biospecimens.pdf	07/31/2014
Field Materials - English	19_Field_Data_Collection_Materials.pdf	07/31/2014
Field Materials - Spanish	19_Field_Data_Collection_Materials_Spanish.pdf	07/31/2014
Data Confidentially Procedures	17_Procedures_for_Keeping_Data_Confidential.pdf	07/31/2014
Data Use Agreement	18_ICPSR_Data_Use_Agreement.pdf	07/31/2014
Key Survey Design Features	8_Key_Design_Features.pdf	07/31/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.